Impact of Surgical Scar onCongenital Heart isease Patients (Thesis Proposal Sample)

Psychological impact for surgical scar post cardiac surgery in congenital heart disease patients
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(30, 06, 2013)
Proposed Title of Integrating Study
Psychological impact of surgical scar post cardiac surgery on congenital heart disease patients
Objectives of the Study
The objectives are
To critically analyse the literature relating to a surgical scar.
To explore the impact of a surgical scar on quality of life(body image and confidence)
To discuss the role of the nurse in managing patients with the post operative reassurance in relation to the surgical scar
To discuss the current recommendations for the best practice of psychological support. 
Main Themes Derived Literature Reviewed
Surgery on patients with congenital heart disease often leaves scars. The resulting scars are believed to pose a significant danger on patients' body image as well as on other aspects of their day to day activities. For instance, in a research study undertaken by KaÅ„toch, Eustace, Collins-Nakai, Taylor , Bolsvert and Lysak (2006) to determine the significance effects of cardiac surgery scars on congenital heart disease patients showed that 60 percent of the patients reported less affect of the scars in their adult life. Nonetheless, 20 percent stated that chest scars led to decreased self esteem, while 18 percent reported decreased self-confidence. 61 percent stated that it resulted in a more positive effect on health appreciation. Other aspects of life such as choice of recreation, sexual relationships, life success, and career choice were less affected by surgery scars. These results have been reflected in a research study carried out by Stefaniak and Adamczyk et al. (2010) which indicated that body image is restored after surgery is performed since the emerging scars have less effect.
In their research Gaca, Jaggers, Dudley, and Bisset (2008) stated that surgery ensures the restoration of personal image after cardiac surgery has been performed. In a separate study carried by Szili-Torok, Kornyei and Jordaens (2008), the researchers established that the existence of surgical scar among congenital heart disease (CHD) exposes the patient to cardiac arrhythmias (Walsh 2008; Walsh & Cecchin 2007). This is because as CHD patients get to adulthood they become more susceptible to cardiac arrhythmias. Moreover, other studies have shown that after a successful cardiac surgery, the patient experiences chronic pain. In an article by Hallin (2012), the findings indicate that surgical scars associated with cardiac surgery result in feelings of rejection, unattractiveness, and uncertainty especially among young female patients with congenital heart disease. In a separate Canadian study, it emerged that cardiac scar has less effect on sexual relationships. In addition, over half of the patients used in the Canadian study stated that they experienced permanent disfigurement resulting from a cardiac scar (Hallin 2012).
In a study to determine the medical predictors’ associated with psychopathology after adults with CHD were operated, it was found that cardiac scars result to emotional and behavioral problems (van Rijen & Utens et al. 2004). This was high among women especially when restricted and engaged in low exercise capacity. The attitudes of patients with congenital heart disease differ depending on the type of the cardiac scar. For example, in their study Crossland and Jackson et al. (2005) compared the attitudes of patients to sternotomy and thoracotomy scars achieved after congenital heart disease surgery. In the study, 201 patients with a cardiac scar as a result of CHD surgery were interviewed on their attitudes towards the scar where 22% of the patients hated their sternotomy scars. Moreover, 28% of the patients with thoracotomy scars and 28% of both hated their scars. Patients with thoracotomy scars were more embarrassed by the choice of clothes compared to those with sternotomy scars. In their conclusion, Crossland and Jackson et al. (2005) noted that adult patients with congenital heart disease and had underwent surgery were more likely to have a negative attitude towards thoracotomy scar compared to sternotomy scar.
There are multiple psychological symptoms associated with patients who have undergone surgery for CHD correction. Some of these symptoms are such as paranoid ideation, phobic anxiety, hostility, anxiety, depression, interpersonal sensitivity, obsession-compulsion, and somatization (Geyer, Norozi, Zoege, Kempa, Buchhorn & Wessel 2006). The research further probed 343 patients (both females and males) on their perception towards body image. Upon taking their social economic positions and age into consideration, Geyer et al. (2006) explored vitality and body rejection. It emerged that most patients rejected their body image after the surgery when they perceived deficiency of disfigurement. Moreover, the stated psychological symptoms were highly influenced by body image perception. Visible scars are left after a multiple palliative surgical procedures are carried to correct single-ventricle congenital heart disease. The scars are believed to have effect not only to body image but also to body mass image and self-esteem among adults and adolescents. These assertions have been reflected in a study conducted by Pike, Evangelista, Doering, Eastwood, Lewis & Child (2012) which established that female patients of the age below 21 years registered lower perceived body-image. Moreover, both female adults and adolescents registered lower body image than men. However, self-esteem was enhanced as the adolescents’ matured and psychological distress decreased.
Nurses are trained to undertake different roles. One of such roles is to manage patients with post operative reassurance in reference to surgical scars (Klipfel, Jacobson, & Havel 2010). For example, nurses are known to develop a comprehensive care plan which addresses the needs of a congenital heart disease patient. Nurses undertake a holistic assessment on the psychological and physical health of the patient. Other roles played by nurses’ during the postoperative reassurance after heart surgery are such as postoperative neurologic management, assessment for renal dysfunction, gastrointestinal complications, pain assessment, and psychological support (Martin &Turkelson 2006)
Reference List
Crossland, D S &a...